[Federal Register: December 5, 2003 (Volume 68, Number 234)]
[Rules and Regulations]
[Page 67955-67960]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr05de03-10]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 412, 413, 476, and 484
[CMS-3055-F]
RIN 0938-AK68
Medicare Program; Photocopying Reimbursement Methodology
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This final rule increases the rate of reimbursement for
expenses incurred by prospective payment system (PPS) hospitals for
photocopying medical records requested by Quality Improvement
Organizations (QIOs), formerly known as Utilization and Quality Control
Peer Review Organizations (PROs). We are increasing the rate from 7
cents per page to 12 cents per page to reflect inflationary changes in
the labor and supply cost components of the formula.
This final rule also provides for the periodic review and
adjustment of the per-page reimbursement rate to account for inflation
and changes in technology. The methodology for calculating the per-page
reimbursement rate will remain unchanged.
We are also providing for the payment of the expenses of furnishing
photocopies to QIOs, to other providers subject to a PPS (for example,
skilled nursing facilities and home health agencies), in accordance
with the rules established for reimbursing PPS hospitals for these
expenses.
EFFECTIVE DATE: These regulations are effective on January 5, 2004.
FOR FURTHER INFORMATION CONTACT: Les Caplan, (410) 786-7223.
SUPPLEMENTARY INFORMATION:
I. Background
Section 1866(a)(1)(F) of the Social Security Act (the Act) requires
a hospital, as a condition of Medicare participation, to enter into an
agreement with a quality improvement organization (QIO), for the peer
review of Medicare services provided by the hospital. (Note: QIOs were
formerly known as peer review organizations (PROs). We published a
final rule with comment period on May 24, 2002 (67 FR 36539), changing
the name to QIOs.) Our regulations at 42 CFR 476.78 provide that health
care facilities that
[[Page 67956]]
submit Medicare claims must cooperate in the conduct of QIO reviews,
including providing the QIO with information necessary to its
determinations. This often includes providing the QIO with photocopies
of patients' medical records.
We published a final rule on October 20, 1992, in the Federal
Register (57 FR 47779), following notice-and-comment rulemaking, which
established a formula for calculating the rate of reimbursement for
these photocopy costs incurred by hospitals. Using this formula, we set
the rate at 7 cents per page. The regulation requires us to determine a
fixed payment amount per page by adding per-page labor costs and per-
page supply costs. The regulation also provides for Medicare payment
for the costs of first class postage for mailing records to QIOs. As
discussed in detail in the October 20, 1992, final rule (57 FR 47779),
the payment established by Sec. 476.78 represents an additional
payment to hospitals under the prospective payment system (PPS) for
photocopy costs. Payment for the equipment and overhead costs
associated with furnishing the QIO with required documentation is made
under other Medicare payment provisions for capital-related costs and
inpatient operating costs.
The formula for calculating the per-page reimbursement rate for
photocopies is set forth at Sec. 476.78(c), which provides:
Photocopying reimbursement methodology for prospective payment
system hospitals. Hospitals subject to the prospective payment system
are paid for the photocopying costs that are directly attributable to
the hospitals' responsibility to the QIOs to provide photocopies of
requested hospital records. The payment is in addition to payment
already provided for these costs under other provisions of the Social
Security Act and is based on a fixed amount per page as determined by
CMS as follows:
(1) Step one. CMS adds the annual salary of a photocopy machine
operator and the costs of fringe benefits as determined in accordance
with the principles set forth in OMB circular A-76.
(2) Step two. CMS divides the amount determined in paragraph (c)(1)
of this section by the number of pages that can be reasonably expected
to be made annually by the photocopy machine operator to establish the
labor cost per page.
(3) CMS adds to the per-page labor cost determined in paragraph
(c)(2) of this section the per-page costs of supplies.
Using this formula we established the per-page rate of 7 cents in
the October 20, 1992, final rule. The validity of this rule and its
reimbursement methodology were challenged in a certified class action
by Medicare--participating hospitals, in the U.S. Court of Appeals for
the Ninth Circuit. Queen of Angels/Hollywood Presbyterian Medical
Center v. Shalala, 65 F.3d 1472, 1476 (9th Cir. 1995). The Court of
Appeals upheld the validity of our photocopy reimbursement methodology
and sustained the lawfulness of the 7 cents per page rate established
in the rule.
Due to increases in labor and supply costs, we are increasing the
reimbursement rate from 7 cents per page to 12 cents per page in
accordance with the established court-approved methodology set forth in
Sec. 476.78(c).
Current Photocopy Reimbursement Rate
Under the current regulation, we apply a uniform per-page rate on a
nationwide basis to all PPS hospitals that have QIO agreements. We base
the calculation on labor and supply costs. The calculation in the
current rule, as discussed in the preamble to the October 20, 1992,
rule, is based on the following:
[sbull] An operator will copy approximately 364,320 pages annually.
[sbull] The salary level of an operator is equivalent to a GS-5
experienced midlevel secretary ($17,686) plus 27.9 percent fringe
benefits ($4,934) for a total salary of $22,620.
[sbull] Paper costs are 0.5 cents per page ($25 per case of paper
with 5,000 sheets in a case).
[sbull] Toner and developer costs are 0.5 cents per page.
The total cost per page is 7 cents.
II. Provisions of the Proposed Regulations
On November 22, 2002, we published a proposed rule (67 FR 70358) in
which we proposed to increase the rate of QIO-related photocopy
reimbursement from 7 cents to 12 cents per page. We calculated this
rate by updating the salary, fringe benefits, and supply figures used
in the October 20, 1992, final rule. In accordance with the methodology
at Sec. 476.78(c), we considered the following factors in calculating
the proposed rate: (1) The labor costs associated with photocopying and
(2) the costs of supplies.
A. Labor Costs
Labor costs were calculated consistent with the methodology at
Sec. 476.78(c), first, by adding the annual salary of a photocopy
machine operator with the costs of fringe benefits, and second, by
dividing that sum by the number of pages that can reasonably be
expected to be made in a year.
B. Annual Salary of a Photocopy Machine Operator
In the October 20, 1992, rule, we adopted the salary level for an
experienced (GS-5) midlevel secretary in the Federal government as
representative of that of a photocopy machine operator. Use of this
figure approximated or exceeded the actual salary information for
individuals performing these tasks that had been submitted by various
commenters. Furthermore, we determined that use of this salary level
yielded payments that were more than adequate to ensure a sufficient
skill level. The annual salary of $17,686 used in the October 20, 1992,
rule was derived from the U.S. Office of Personnel Management's 1992
General Schedule.
In this final rule, we will continue to deem the salary of a
Federal GS-5 midlevel secretary as representative of a photocopy
operator's salary; however, we will update the figure to take into
account increases in the payment rate of a midlevel secretary. Thus, as
discussed in the proposed rule, we are using the GS-5 annual salary of
$28,727 derived from the U.S. Office of Personnel Management's 2002
General Schedule to calculate the revised rate.
C. Fringe Benefits
In the October 20, 1992, final rule, we ascribed the fringe
benefits of an employee to be 27.9 percent of the employee's salary,
which was the standard percentage dictated by the cost principles set
forth in the Office of Management and Budget (OMB) Circular A-76. While
there may be other yardsticks to measure this component of costs, we
find this to be a reasonable resource since the thrust of this OMB
circular is to help the government compare potentially incurred costs
to determine whether the costs can be more economically incurred
internally or through contract with a commercial source. Therefore, we
continue to use OMB Circular A-76 to calculate the annual fringe
benefit cost. Accordingly, fringe benefits were calculated in the
November 22, 2002, proposed rule based on 29.7 percent of the GS-5
salary as outlined in the OMB Circular A-76 Transmittal Memorandum 19--
FY 2000 estimate. Thus, the annual fringe benefit cost is $8,532
($28,727 * 29.7 percent).
[[Page 67957]]
D. Number of Pages Copied Annually
In this final rule, we are using 364,320 pages per year in the
calculation of the annual labor cost. In the October 20, 1992, rule, we
determined that 364,320 was the number of pages that could reasonably
be expected to be copied in a year. Earlier, in the proposed rule
``Changes to Peer Review Organizations Regulations'', published on
March 16, 1988, at 53 FR 8654, we had proposed the use of 748,000 pages
per year in the calculation of the annual labor cost. This initial
figure was determined based on copying documents at a rate of six pages
per minute for each hour in an 8 hour day, 5 days a week, 52 weeks per
year. The estimate was based on hand feeding of documents into the
photocopying machine for duplication, although we recognized that there
are many photocopying tasks that may be accomplished through automatic
feeds. Automatic feeds greatly increase the number of pages that can be
generated by a machine on an hourly basis, and as a result, greatly
decrease the cost of photocopying per page.
In response to comments received on the March 16, 1988, proposed
rule (53 FR 8654), we revised the 748,000 figure in the October 20,
1992, final rule to account for time spent by the photocopy machine
operator in search and retrieval tasks, and time away from work on
annual vacation, sick, and holiday leave. This resulted in a reduction
from 748,000 to 364,320 in our estimate of the number of pages that may
be reasonably expected to be made annually, and a corresponding
increase in the per-page labor rate.
We are unaware of any significant changes in technology since the
October 20, 1992, final rule (57 FR 47779) that would lead to either a
significant decrease or increase in the annual number of pages that may
be copied. Nor are we aware of any changes that would significantly
increase or decrease the time allocated to search and retrieval tasks.
Therefore, we continue to use the 364,320 figure to calculate the per-
page labor cost.
E. Calculation of Per-Page Labor Costs
To determine the per-page labor cost, the total of salary ($28,727)
and fringe benefits ($8,532) costs, which amount to $37,259, was
divided by 364,320 pages, the number of copies made in a year,
resulting in an annual labor cost per page of 10 cents ($37,259/364,320
pages).
F. Supply Costs
In the proposed rule, we proposed a total supply cost of 2.3 cents
per page. This is based on a per-page paper cost of 0.5 cents and a
developer and toner cartridge cost of 1.8 cents per page. The paper
costs were calculated based on $23 per case of paper with 5,000 sheets
in a case. This equates to 0.5 cents per page ($23/5,000).
In this rule, we used an objective methodology to calculate the
per-page cost for toner and developer that can also be used in future
updates. We calculated these costs using estimates of the costs for
toner cartridges and developer drums contained in the General Services
Administration (GSA) supply catalogue, and on the basis of a photocopy
machine producing 364,320 pages annually.
G. Payment Rate Per Page
Consistent with Sec. 476.78(c)(3), the payment rate per page is
the total of the per-page labor cost and the per-page supply cost,
which is equivalent to 12 cents. The established calculation
methodology actually results in a cost of 12.3 cents per page, however,
consistent with our policy and generally accepted mathematics
principles, we chose to round down to 12 cents. We believe this
decision is both reasonable and supportable, based on the fact that the
higher amount substantially exceeds all published OMB inflation
indexes, including the Consumer Price Index (CPI)-Wage index
(photocopying expense is largely comprised of labor costs).
H. Future Updates to Rate of Photocopy Reimbursement
In addition to updating the rate of reimbursement for photocopies,
we are also amending the existing regulation to permit the rate to be
adjusted without undergoing notice-and-comment rulemaking each time it
needs to be adjusted to reflect inflationary or technology changes.
We intend to review and adjust the rate periodically in accordance
with the same factors considered in establishing the rate in the
October 20, 1992, final rule and the updated rate in this final rule.
This review will include an examination of the labor and supply
components of the formula, and we will update the rate as necessary to
account for significant inflationary changes to these components.
Absent some compelling reason, in future updates, we will continue
to deem the salary and fringe benefits of a Federal government GS-5
midlevel secretary as representative of the salary and fringe benefits
of a photocopy machine operator and use those values to calculate the
reimbursement rate. Also, absent some compelling reason or major
technological change that would lead to a significant increase or
decrease in the number of pages that can be made annually, we will not
change the number of pages used in calculating the rate.
I. Reimbursement to Other PPS Providers of the Cost of Photocopying
We will provide for the payment of the expenses of furnishing
photocopies to QIOs, to other providers subject to a PPS (for example,
skilled nursing facilities (SNFs) and home health agencies (HHAs)), in
accordance with the rules established at Sec. 476.78 for reimbursing
PPS hospitals for these expenses.
Current regulations do not address reimbursement for providers
other than hospitals for costs of photocopying medical records in
cooperation with QIO review activities because in the past QIO review
of providers other than hospitals was relatively insignificant. To the
extent that this review activity took place, it was minimal, and the
related costs were included on the provider's cost report. SNFs, HHAs,
and other providers have recently converted from the cost-based
reimbursement system to a PPS. Because QIO review of these providers
has been minimal or nonexistent, costs related to this activity are not
adequately reflected in the base PPS rate. Therefore, we believe it is
appropriate to provide for a means of paying for these costs when they
occur. To accomplish this change, we will replace the more narrow term
``hospitals'' with ``providers,'' in Sec. 476.78(b)(2) and (c), to
include other providers subject to a PPS.
Additionally, we will revise the payment provisions for SNFs and
HHAs by adding a paragraph at Sec. 413.355 and Sec. 484.265, that
authorizes reimbursement for the costs of photocopying and mailing
medical records required for QIO review, to SNFs and HHAs.
We will amend Sec. 476.78(d) to provide that, as with other
disputes regarding Medicare payment to providers, disputes concerning
payments for costs related to QIO review under Sec. 476.78 and the
other payment provisions of the Medicare statute and regulations must
be presented in accordance with the administrative and judicial review
requirements of section 1878 of the Act and subpart R of 42 CFR part
405.
III. Analysis of and Responses to Public Comments
We received three timely items of correspondence in response to the
proposed rule published on November 22, 2002. A summary of the major
issues
[[Page 67958]]
raised in those comments and our responses follow:
Comment: One QIO commented that the November 22, 2002, proposed
rule would increase pass-through photocopy costs well beyond the amount
budgeted in their seventh round Medicare contract. This increase could
cause the QIO to exceed the total cost of its contract.
Response: Increased photocopying costs are included in the seventh
round scope of work funding level. However, these costs are a true
pass-through; that is, CMS is responsible for paying providers, and CMS
uses its QIO contractors as the vehicle to pay them. Although CMS does
not anticipate increasing the total cost of each QIO contract
immediately upon publication of this rule, any time a QIO believes it
will exceed the total cost of its contract, the QIO should immediately
notify CMS (see ``Limitation of Cost'' clause in the seventh round
contract). If the excess costs are the result of increased photocopying
reimbursement, CMS will exercise one of the four options CMS always
uses in similar cases--we will either request that money be added to
the contract, reduce work, ask the QIO to move funds between cost
centers or line items, or some combination of these options. In no case
will CMS expect the QIO to absorb any excess pass-through with existing
contract funds without a corresponding reduction or shifting in level
of effort.
Comment: One hospital commented that the method for calculating
labor costs described in section II.A of the preamble of the November
22, 2002, proposed rule only provides for the cost of a photocopy
machine operator, while in actual practice a significant portion of
records reproduction time should be attributed to record retrieval,
review, and re-filing by a records technician. The hospital further
stated its pay scale for a records technician ranges from $8.30 to
$11.22 per hour.
Response: We agree with this comment. However, in section II.D of
the preamble of the November 22, 2002, proposed rule, we explained how
we calculated the estimated number of pages copied annually. As
discussed in detail at 57 FR 47780, this estimate was adjusted before
publication of the current regulation to take into account the
appropriate amount of labor time required to perform all of the steps
that are performed in addition to the actual photocopying, such as
logging in the request, retrieving the record, refiling the record, and
mailing copies. Thus, the term ``photocopy machine operator'' can
reasonably be interpreted to include records technicians or anyone else
directly involved in the hands-on process. Further, section II.B of the
preamble of the November 22, 2002, proposed rule explains that we used
an updated representative annual salary of $28,727, or an hourly rate
of $13.81, which exceeds this provider's salary range for a records
technician. Therefore, we have not increased the per-page reimbursement
rate based on this comment.
Comment: Another commenter questioned the raw data we applied to
the approved methodology for calculating the per-page cost of
photocopying medical records. Although this commenter strongly
supported the three primary objectives of the rule (to increase
reimbursement, extend provisions of the rule to all PPS providers, and
allow for periodic adjustment of rates without notice and comment
rulemaking), the commenter contended the rate should be significantly
higher than the proposed 12 cents per page.
In particular, this organization stated the proposed labor rate is
insufficient to retain qualified personnel in the private sector,
fringe benefit rates are too low, the number of pages copied annually
is too high due to recent Health Insurance Portability and
Accountability Act of 1996 (HIPAA) requirements, and the cost of
supplies is too low as a result of comparing GSA bulk purchase costs to
actual costs available to private sector companies. The commenter
believes we used the October 20, 1992, regulation as a starting point
for current calculations and that regulation was based on artificially
low cost assumptions.
The commenter supports extending the proposed reimbursement
methodology to non-hospital PPS providers and also supported the
periodic review provisions. However, the commenter asked us to amend
the rate review section to require such a review at no more than 5-year
intervals.
Response: In this rule, we used recent cost data to calculate the
proposed per-page photocopy costs and did not simply build on 1992
data. However, we believe that the data used in both this rule and the
1992 rule is reasonable and accurately reflects the costs associated
with this responsibility. Further, we believe the proposed
representative salary and fringe benefit rates of $28,727 and 29.7
percent, respectively, are reasonable and sufficient to attract and
retain qualified personnel. The fringe benefit (F/B) rate, in
particular, is very close to the mean F/B rate of the numerous
contractors we reviewed before publication of the November 22, 2002,
proposed rule, to validate the A-76 Transmittal Memorandum. Although
the 29.7 percent F/B rate is based on the 2000 OMB guidance, we have
applied it to a higher base figure and see no reason to adjust it
further. The $28,727 salary estimate represents a mid-level GS-5
secretary salary in 2002, which we believe is a fair and accurate
comparison to the skill level necessary to process medical record
photocopying requests.
The estimated number of pages has remained constant since the
October 20, 1992, regulation was published. Although the commenter may
be correct that HIPAA privacy requirements will modestly reduce the
maximum number of pages an operator or technician can copy per year, it
is still too soon to calculate the exact effect of that legislation.
Further, we believe that increases in the speed and simplicity of
reproduction hardware over the last 10 years may offset any decreases
in volume resulting from HIPAA.
The comment that the cost of supplies to non-governmental
organizations exceeds the GSA catalogue price may be valid. However,
the GSA price provides a solid benchmark that does not vary widely by
vendor or product quality. Further, our proposed overall reimbursement
rate per page amounts to a 7 percent annual increase over the 10 years
since publication of the previous rule. This is approximately twice the
inflation index rate and adequately compensates for any modest
differences between the government and private-sector costs of
supplies.
We believe the suggestion to include a maximum 5-year interval
between review periods has some merit but may be unnecessary. By
eliminating the need for notice and comment rulemaking, it becomes
unlikely that any future rate adjustment will take longer than 5 years
and potentially could be more frequent.
IV. Provisions of the Final Regulations
This final rule incorporates the provisions of the proposed rule
with only one minor change. We have deleted the proposed revision of
Sec. 476.78(b)(4), thus leaving that section unchanged from the
existing text. The proposed amendment, replacing ``hospital'' with
``provider,'' had an unintended consequence of appearing to extend the
requirement to provide QIOs with discharge notices from hospitals to
other inpatient providers. That is neither the purpose nor the intent
of this final rule.
V. Collection of Information Requirements
Under the Paperwork Reduction Act (PRA) of 1995, agencies are
required to provide 60-day notice in the Federal
[[Page 67959]]
Register and solicit public comment before a collection of information
requirement is submitted to the Office of Management and Budget (OMB)
for review and approval. In order to fairly evaluate whether an
information collection should be approved, section 3506(c)(2)(A) of the
PRA of 1995 requires that we solicit comment on the following issues:
[sbull] Whether the information collection is necessary and useful
to carry out the proper functions of the agency;
[sbull] The accuracy of the agency's estimate of the information
collection burden;
[sbull] The quality, utility, and clarity of the information to be
collected; and
[sbull] Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
Section 476.78 of this regulation contains information collection
requirements. In summary, Sec. 476.78 requires providers to submit
information to the QIO during the conduct of a QIO review. Because this
information is collected during the conduct of an audit, investigation,
and/or an administrative action, we believe these collection
requirements are not subject to the PRA as stipulated under 5 CFR
1320.4.
VI. Regulatory Impact
We have examined the impacts of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-354),
section 1102(b) of the Social Security Act, the Unfunded Mandates
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 (as amended by Executive Order 13258, which
merely reassigns responsibility of duties) directs agencies to assess
all costs and benefits of available regulatory alternatives and when
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, distributive impacts, and equity). A
regulatory impact analysis (RIA) must be prepared for rules that
constitute significant regulatory action, including rules that have an
economic effect of $100 million or more annually. This final rule is
not a major rule in terms of the aggregate costs involved.
The 53 separate QIO contracts are awarded on a staggered 3-year
basis. Current sixth scope of work contracts provide photocopy
reimbursement costs of 7 cents per page. The total dollars budgeted
were $8.6 million per year and the 3-year costs were $25.9 million. We
estimate by the time this final regulation is published, 19 QIOs will
have completed their sixth round contracts, and the other 34 will have
less than 153 months (combined) out of a total of 636 months (for all
53 QIOs) remaining in the final year of their sixth round contracts.
This translates to 24 percent of the final sixth round year. As such,
we project this regulation will increase the costs in the last (that
is, current) year of the sixth scope of work by $1.5 million above the
previous budgeted level of $8.6 million, to a total of $10.1 million.
However, in future years--based on the full 12 months and all 53 QIOs
under contract--the increase will be nearly $6.2 million annually.
Thus, we have determined that this final rule is not a major rule
with economically significant effects because it will not result in
increases in total expenditures of $100 million or more per year.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and small governmental
jurisdictions. Most hospitals and most other providers and suppliers
are small entities, either by nonprofit status or by having revenues of
$6 million to $29 million or less annually (see 65 FR 69432).
Individuals and States are not included in the definition of a small
entity.
We generally prepare a regulatory flexibility analysis that is
consistent with the RFA unless we certify that a rule will not have a
significant impact on a substantial number of small entities. We have
not prepared an analysis for the RFA because we have determined, and
certify, that this final rule will have no significant economic impact
on small entities. The regulation will not impose any economic or
operational regulatory burdens on small entities. The regulation will
only assist providers in performing the tasks required under the QIO
program sixth scope of work, by increasing the reimbursement for
providing copies of documents to the QIOs.
Section 1102(b) of the Act requires us to prepare a regulatory
impact analysis if a rule may have a significant impact on the
operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 604 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a Metropolitan
Statistical Area and has fewer than 100 beds. We have not prepared an
analysis for section 1102(b) of the Act because we have determined that
this final regulation will not have a significant impact on the
operations of small rural hospitals for the reasons stated above in our
discussion of the RFA.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies prepare an assessment of anticipated costs and
benefits before issuing any rule that may result in an expenditure in
any 1 year by State, local, or tribal governments, in the aggregate, or
by the private sector, of $110 million or more. We have determined that
this final rule will not result in such an expenditure. Rather, the
final rule will benefit providers by increasing the photocopy
reimbursement rate.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a rule that imposes substantial
direct compliance costs on State and local governments, preempts State
law, or otherwise has Federalism implications. We have reviewed this
final rule under the threshold criteria of Executive Order 13132 and
have determined that it will not have a substantial direct effect on
the rights, roles, and responsibilities of States or local governments.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
List of Subjects
42 CFR Part 412
Administrative practice and procedure, Health facilities, Medicare,
Puerto Rico, Reporting and recordkeeping requirements.
42 CFR Part 413
Health facilities, Kidney diseases, Medicare, Puerto Rico,
Reporting and recordkeeping requirements.
42 CFR Part 476
Grant programs-health, Health care, Health facilities, Health
professions, Quality Improvement Organizations (QIO), Reporting and
record keeping requirements.
42 CFR Part 484
Health facilities, Health professions, Medicare, Reporting and
recordkeeping requirements.
0
For the reasons set forth in the preamble, the Centers for Medicare &
Medicaid Services is amending 42 CFR chapter IV as follows:
[[Page 67960]]
PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL
SERVICES
Subpart H--Payment to Hospitals Under the Prospective Payment
Systems
0
1. The authority citation for part 412 continues to read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
0
2. In Sec. 412.115, revise paragraph (c) to read as follows:
Sec. 412.115 Additional payments.
* * * * *
(c) QIO photocopy and mailing costs. An additional payment is made
to a hospital in accordance with Sec. 476.78 of this chapter for the
costs of photocopying and mailing medical records requested by a QIO.
PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR
END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT
RATES FOR SKILLED NURSING FACILITIES
Subpart J--Prospective Payment for Skilled Nursing Facilities
0
1. The authority citation for part 413 continues to read as follows:
Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and
(n), 1871, 1881, 1883, and 1886 of the Social Security Act (42
U.S.C. 1302, 1395d(d), 1395f(b), 1395l(a), (i), and (n), 1395hh,
1395rr, 1395tt, and 1395ww).
0
2. Add a new Sec. 413.355 to read as follows:
Sec. 413.355 Additional payment: QIO photocopy and mailing costs.
An additional payment is made to a skilled nursing facility in
accordance with Sec. 476.78 of this chapter for the costs of
photocopying and mailing medical records requested by a QIO.
PART 476--UTILIZATION AND QUALITY CONTROL REVIEW
Subpart C--Review Responsibilities of Quality Improvement
Organizations (QIOs)
General Provisions
0
1. The authority citation for part 476 continues to read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
0
2. In Sec. 476.78, revise the introductory text to paragraph (b);
revise paragraphs (b)(2), and the introductory text to paragraph (c);
add new paragraph (c)(4); and revise paragraph (d) to read as follows:
Sec. 476.78 Responsibilities of health care providers.
* * * * *
(b) Cooperation with QIOs. Health care providers that submit
Medicare claims must cooperate in the assumption and conduct of QIO
review. Providers must--
* * * * *
(2) Provide patient care data and other pertinent data to the QIO
at the time the QIO is collecting review information that is required
for the QIO to make its determinations. The provider must photocopy and
deliver to the QIO all required information within 30 days of a
request. QIOs pay providers paid under the prospective payment system
for the costs of photocopying records requested by the QIO in
accordance with the payment rate determined under the methodology
described in paragraph (c) of this section and for first class postage
for mailing the records to the QIO. When the QIO does postadmission,
preprocedure review, the facility must provide the necessary
information before the procedure is performed, unless it must be
performed on an emergency basis.
* * * * *
(c) Photocopying reimbursement methodology for prospective payment
system providers. Providers subject to the prospective payment system
are paid for the photocopying costs that are directly attributable to
the providers' responsibility to the QIOs to provide photocopies of
requested provider records. The payment is in addition to payment
already provided for these costs under other provisions of the Social
Security Act and is based on a fixed amount per page as determined by
CMS as follows:
* * * * *
(4) CMS will periodically review the photocopy reimbursement rate
to ensure that it still accurately reflects provider costs. CMS will
publish any changes to the rate in a Federal Register notice.
(d) Appeals. Reimbursement for the costs of photocopying and
mailing records for QIO review is an additional payment to providers
under the prospective payment system, as specified in Sec. 412.115,
Sec. 413.355, and Sec. 484.265 of this chapter. Thus, appeals
concerning these costs are subject to the review process specified in
part 405, subpart R of this chapter.
PART 484--HOME HEALTH SERVICES
Subpart E--Prospective Payment System for Home Health Agencies
0
1. The authority citation for part 484 continues to read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395(hh) unless otherwise indicated.
0
2. Add a new Sec. 484.265 to read as follows:
Sec. 484.265 Additional payment.
QIO photocopy and mailing costs. An additional payment is made to a
home health agency in accordance with Sec. 476.78 of this chapter for
the costs of photocopying and mailing medical records requested by a
QIO.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: May 23, 2003.
Thomas A. Scully,
Administrator, Center for Medicare & Medicaid Services.
Approved: August 28, 2003.
Tommy G. Thompson,
Secretary.
[FR Doc. 03-30096 Filed 11-28-03; 11:32 am]
BILLING CODE 4120-01-P